Leventhal, J.M., Larson, I.A., Abdoo, D., Singaracharlu, S. & al. (2007). Are abusive fractures in young children becoming less common? Changes over 24 years. Child Abuse & Neglect, 33(3), 311-322.
This study examined trends in abusive fractures in children less than 36 months of age evaluated at Yale-New Haven Children’s Hospital (Connecticut) from 1979 to 2002. After reviewing the abstracted and radiographic medical records, two clinicians (including one expert on child abuse) and two pediatric radiologists each rated the likelihood of abuse using explicit criteria and a seven-point scale that ranged from “definite abuse” to “definite unintentional injury”. The proportions of cases rated as abuse were then compared over time periods, and the adjusted odds ratios (OR) were calculated through logistic regression. The proportion of cases rated as abuse decreased from 22% from 1979 to 1983, to 10% from 1991 to 2002 (p < .001). The odds that a given case was rated as abuse therefore decreased by over 50% over this period. The authors speculate that this decrease may be due to improved early detection of high risk families. Although this is restricted to one hospital, the results are encouraging enough to warrant confirmatory research in other institutions.
The data presented in this longitudinal study comes from only one hospital and cannot be generalized beyond the hospital’s catchment results. The study did not track fractures treated in non-pediatric hospitals and therefore could not account for biasing self-selection effects. Although it is a retrospective file review, the authors were careful to ensure that all files were independently rated by two clinicians and all radiographs and CT scans were independently rated by two pediatric radiologists.